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PERMIT APPLICATION <br /> BUILDIN G/MECHAN ICAL/PLUM BING/SIG N/SPRIN KLER/D EMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 5200 Cedar St., Everett,W A 98201 -425-257-8810-FAX 425-257-8857-www.everettwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM G�— <br /> ITE ADDRESS: VNOVER7Y TA%N ERMIT K— <br /> p o 53 SR oeoo.� <br /> LEGAL t�r new construclwn' Short P�aUsuEtlivision Lot No._ (��h wpy of lorq legal tlescnptim) <br /> OWNER D�� �U a�i� Phone/E-mail aS -�6�-<S'7"� <br /> ress <br /> y� o,�Y�S�a«o E/-�E//!.!� l.�G�• 9��/S a.56 <br /> CONTRACTOR I�D � l0 N�' L 8 oI Lic.'#I <br /> daress � a� a� ST/{��T�T�' ' b0�/ pMne/Email /t AM � <br /> ENApT BUSINE55 NAME CONTACT FOR PERMR A�/ �J �G�"//l� <br /> c4 59•395-� <br /> AY� 1 tin. s.l �� Scr✓�c�S PMne/E-mail B /�� Ili�ca� <br /> SUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '�� <br /> d HEAT SOURCE: <br /> E�dstirg Use of Building ///!`/��i�u�_ <br /> Proposed Use of Buildirg ��7���� Gas Electric 01her <br /> Buildirg rype: _Sirgle Family _Duplex_Townhouse _Multi-Family �'Commercial <br /> Type M project _New _AdOifion _Remodel _Repair�C T.I._Sign_Sprinkier_Demdi6on_Change of Use <br /> OescnPbon of WoAc(aLtional`Sspac�WovideU on�back : /� �IC 7'7.r// /_.��F��Y� <br /> /NSTJ9� �� J///VC7 K/ <br /> L i�.�v��� <br /> Havp you started woAcing without a permit4 _YES �NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPIICATION <br /> Typ�d ProjecL _New_Addn _Altention_Repair TYpe ot irol�t: _New_Addn _AltenUon_Repair <br /> 5I'ow NumDer W fiatures SM1ow Number W�Mures <br /> WC–airhandli units Toilet <br /> Forced air 5 tems BaMtub <br /> Gas i i Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink 8 dis sal <br /> Gas ran e Dishwasher <br /> Clot�es A er Clothes washer <br /> Ra e Mod Water hea[er <br /> Exhaust fan Sink servicelbar/mo /etc. <br /> Heat um � Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Retri eration Floor drain <br /> Woodstove Grease Va <br /> Ducdn Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM other: <br /> Number ot Heads ��' <br /> I hereby cenify that I have reaC an0 enamineC tnis apD���ation anA know ihe same to be irue antl cortecL All provisions of laws anE ortlinances govemirg <br /> this lype o(work will De complied wilh wfielher specifietl�erein or not.The granting of a permit Eces not presume to give authonry lo violate or cantel <br /> Ihe Dmvision of a�y other state or local law regulating cons uclion or the peAormance ot conslruction.That I am aN�onzeA by the ovmer of this DropeM1y <br /> to peAorm Ihe v.ork f ich apPliwlion i ade and I ply wi�h lhe Slale C tractors Law 18.27 RCW and 296200 WAC <br /> - � � ���� (Revised?l1077) <br /> OwnerlAuRwr ied Ape Slq re <br /> h <br />